HYPOADKENIA 323 



gm. per kilogram. Verdozzi(a) observed that hypertrophy of the cortical 

 tissue occurs during gestation, which he regards as substantiating the 

 belief that the cortex is an important factor in the development and gen- 

 eral nutrition of the organism. There is less positive evidence of the 

 functional activity of the chromaphil tissue in the fetus. Lewis was unable 

 to demonstrate epinephrin in human fetal suprarenals, noting in only 

 two instances of full term glands inconclusive positive tests. Congenital 

 inferiority of the chromaphil tissue is, however, believed to give rise to 

 certain characteristic symptoms associated, in many instances, with status, 

 hypoplasticus, or status thymicolympJiaticus. According to Wiesel(e) and 

 Hedinger, hypoplasia of the chromaphil system is always present in status 

 lymphaticus. It is known, also, that in advanced age the suprarenals lose 

 their vascularity, diminish in size, and frequently undergo atrophy of a 

 retrograde character. The glands, moreover, are regarded as especially 

 vulnerable to the action of toxins, and it is believed by some that all the 

 infections, general and focal, and intoxications, occurring during the life 

 of the individual, may tend to impair the functional activity of these 

 organs. 



According to the reports in the literature the syndrome of functional 

 hypoadrenia has been observed in many clinical conditions. The pos- 

 sible suprarenal origin of some forms of neurasthenia as indicated by the 

 striking similarity in the symptom complexes of hypoadrenia and neuras- 

 thenia has been emphasized by Williams (a-) (&) and others. It seems 

 probable, however, that the epinephropathy is not the only factor in the 

 causation of such neurasthenic symptoms, if, indeed, it plays any part, but 

 that a dysfunction of other endocrin glands is associated with the supra- 

 renal insufficiency, giving rise to the pluriglandular syndrome with uni- 

 giandular predominance of Pende. Many of the cases of neurasthenia, 

 attributed to hypoadrenia might possibly be more properly classified under 

 the thyrotesticular hypophyseal (suprarenal) syndrome of pluriglandular 

 insufficiencies. In such cases there is usually an underlying constitutional 

 inferiority, which predisposes to pluriglandular endocrinopathies in the 

 presence of some noxa interfering with the function of constitutionally 

 feeble glands (Wiesel). 



In the opinion of many recent writers, functional hypoadrenia, due to 

 fatigue or prolonged emotional disturbance, played an important role in 

 the causation of the so-called war neuroses. Pende (&) believes that we 

 may accept the hypothesis of a functional inhibition of the suprarenals due 

 to war. Satre and Gros have described several types of cases, which 

 they regard as fundamentally hypoadrenia, with asthenia, hypotension, 

 gastric disturbances, and neurasthenic symptoms, resulting from the stress 

 of war, acting upon the suprarenal glands, which although competent for 

 civil life, are inadequate for the emergencies of active service. Carles 

 has reported a number of similar cases, regarded as due to suprarenal 



